Choosing treatment and targeted therapy in axial spondyloarthritis

Pharmacological management in the axial spondyloarthritis (axSpA) field has advanced in recent years. Accumulating evidence on long-term efficacy and safety of biological agents targeting TNFa and IL-17, as well as data on JAK inhibitors is now available. Rheumatologists have currently more options for treatment as compared with 20 years ago, but choosing the best therapeutical approach for a single patient remains a challenge. Despite generalized treatment recommendations provided by international societies, patients present with a heterogeneity of symptoms and treatment responses. In the context of personalized medicine, understanding the disease phenotype in combination with extra-musculoskeletal manifestations is a core step for treatment decision making. Beyond disease-related aspects, comorbidities could also be particularly relevant in the selection of the most appropriate drug, given their different efficacy and safety profiles. AxSpA patient's fertility and pregnancy outcomes with regard to therapy also form a consideration, since symptom onset usually falls into the child-bearing age. This article will discuss the selective effect of the approved treatment modalities on the different axSpA manifestations and co-existing conditions.